1780184838 NPI number — MISS BRIANA LYNN REXRODE

Table of content: MISS BRIANA LYNN REXRODE (NPI 1780184838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780184838 NPI number — MISS BRIANA LYNN REXRODE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REXRODE
Provider First Name:
BRIANA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780184838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16198 L P BAILEY MEMORIAL HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NATHALIE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24577-3300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16198 L P BAILEY MEMORIAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATHALIE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24577-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-579-6264
Provider Business Practice Location Address Fax Number:
434-579-6264
Provider Enumeration Date:
02/15/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A201301133 . This is a "EMERGENCY MEDICAL RESPONDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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